HLSA300 ACTUAL EXAM EVALUATION QUESTIONS WITH ANSWERS
2025/2026 GRADED A+
adverse selection - A high-risk person benefits more from insurance, so is more likely to
purchase it.
no out of network, need referrals, copayments, preauthorizations - what are the qualities
of an hmo?
no referrals or preauthorizations, can go out of network, coinsurance - what are the
qualities of a ppo?
no referrals or preauthorizations but cannot go out of network - what are the qualities of
an epo?
need referrals and preauthorizations in network, copayments in network, coinsurance
out of network - what are the qualities of a pos?
over 65, receiving ssi for disability 2 years or more, end stage renal disease - who
qualifies for medicare?
price - the amount that is actually paid to providers after negotiation
charge - the retail price for health services
cost - how much it actually costs to deliver a health service
capitation - paying one set rate for all services rendered during a given time period
drg - paying one fee for multiple services for a specific diagnosis (used by medicare to
pay hospitals)
when quality is greater than cost - when do we get value out of healthcare?
medicare acos - what is an example of an attempt at population health?
yes - do some medicare beneficiaries also use private insurance?
50 million - how many were uninsured in 2009?
EMTALA - law that states that anyone in an emergency or active labor must be treated
regardless of ability to pay, but they can be billed later
childless adults - who was medicaid expanded to?
decrease - after the aca, did employer sponsored insurance increase or decrease?
, eligibility, income of population, employer size and industry, ineligible populations - what
drives variation in insurance among states?
cost sharing prohibitive, networks may be limited, may lack certain benefits, geography,
convenience, cultural beliefs, compliance - why is access not always guaranteed even
with insurance?
no - can the federal gov negotiate with drug companies?
20% - how much profit can insurance companies make for overhead costs?
health policy decisions, growth of technology, other costs - what affects healthcare
costs?
risk - what is the main reason we have health insurance?
both the employer and the employee - who are insurance and other benefits tax
deductible for?
pays at least 60% cost necessary care, no lifetime or annual caps on coverage, must
limit out of pocket expenses - what are the requirements of employer sponsored
insurance?
80% - how much of an employee's premium does an employer usually pay?
job lock - staying at a dead end job bc it has good health coverage that you would
otherwise be able to obtain
yes - can you enroll in medicaid if you are offered esi?
at least 60% actuarial value and no more than 9.69% of an employee's income - what is
the requirement for employer sponsored insurance under the aca?
no - are employers mandated to offer family plans?
2nd lowest silver plan in the region - what are tax credit values based on?
yes - is short term duration insurance able to be individually underwritten still?
6800 - what does aca cap out of pocket costs at?
title xviii - what legislation is medicare under?
balanced budget act - schip was created in 1997 under what legislation?
state and federal gov - who funds schip?
2025/2026 GRADED A+
adverse selection - A high-risk person benefits more from insurance, so is more likely to
purchase it.
no out of network, need referrals, copayments, preauthorizations - what are the qualities
of an hmo?
no referrals or preauthorizations, can go out of network, coinsurance - what are the
qualities of a ppo?
no referrals or preauthorizations but cannot go out of network - what are the qualities of
an epo?
need referrals and preauthorizations in network, copayments in network, coinsurance
out of network - what are the qualities of a pos?
over 65, receiving ssi for disability 2 years or more, end stage renal disease - who
qualifies for medicare?
price - the amount that is actually paid to providers after negotiation
charge - the retail price for health services
cost - how much it actually costs to deliver a health service
capitation - paying one set rate for all services rendered during a given time period
drg - paying one fee for multiple services for a specific diagnosis (used by medicare to
pay hospitals)
when quality is greater than cost - when do we get value out of healthcare?
medicare acos - what is an example of an attempt at population health?
yes - do some medicare beneficiaries also use private insurance?
50 million - how many were uninsured in 2009?
EMTALA - law that states that anyone in an emergency or active labor must be treated
regardless of ability to pay, but they can be billed later
childless adults - who was medicaid expanded to?
decrease - after the aca, did employer sponsored insurance increase or decrease?
, eligibility, income of population, employer size and industry, ineligible populations - what
drives variation in insurance among states?
cost sharing prohibitive, networks may be limited, may lack certain benefits, geography,
convenience, cultural beliefs, compliance - why is access not always guaranteed even
with insurance?
no - can the federal gov negotiate with drug companies?
20% - how much profit can insurance companies make for overhead costs?
health policy decisions, growth of technology, other costs - what affects healthcare
costs?
risk - what is the main reason we have health insurance?
both the employer and the employee - who are insurance and other benefits tax
deductible for?
pays at least 60% cost necessary care, no lifetime or annual caps on coverage, must
limit out of pocket expenses - what are the requirements of employer sponsored
insurance?
80% - how much of an employee's premium does an employer usually pay?
job lock - staying at a dead end job bc it has good health coverage that you would
otherwise be able to obtain
yes - can you enroll in medicaid if you are offered esi?
at least 60% actuarial value and no more than 9.69% of an employee's income - what is
the requirement for employer sponsored insurance under the aca?
no - are employers mandated to offer family plans?
2nd lowest silver plan in the region - what are tax credit values based on?
yes - is short term duration insurance able to be individually underwritten still?
6800 - what does aca cap out of pocket costs at?
title xviii - what legislation is medicare under?
balanced budget act - schip was created in 1997 under what legislation?
state and federal gov - who funds schip?
